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Article Reviewed

Myers JS, Bellini LM.  Leveraging the Continuum: A Novel Approach to Meeting Quality Improvement and Patient Safety Competency Requirements Across a Large Department of Medicine.  Acad Med 2018;93:1321   
doi: 10.1097/ACM.0000000000002291
https://www.ncbi.nlm.nih.gov/pubmed/29794518

Background

Despite being essential competencies, Quality Improvement (QI) and Patient Safety (PS) are skills that training programs still struggle to teach due to lack of a standardized curriculum or experienced faculty.

Objective

This study described implementation of a single vertically integrated curriculum designed to teach QI/PS across all levels of graduate medical trainees in the Department of Medicine at University of Pennsylvania.

Study Design

QI/PS was identified as one of several competency-based themes into which the core curriculum was organized for all levels of trainees in the Department of Medicine.  Training for these components was supervised by sixteen faculty core members who had been trained by one faculty member, the theme director, who was proficient in QI/PS.

PS event (PSE) reporting, adverse events disclosure (AED), root cause analysis (RCA) and engagement in QI initiatives were identified as core elements of the QI/PS curriculum.

Training in PSE reporting was conducted through brief 60- to 90-minute sessions that employed specialty-specific examples to highlight each trainee's role and provided hands on experience for submitting reports. RCA training involved mandatory participation in institutional and mock RCAs. AED was taught using case discussion and simulated patient/family encounters . QI skills were honed through longitudinal workshops and experiential projects aligned with quality goals for the division or department. 

While the curriculum content was the same across levels, the emphasis built vertically from basic QI/PS concepts for more junior residents to institutional integration and delivery for fellows. 

Results

Robust participation was noted in all the QI/PS activities. Trainees overwhelmingly rated all components of the curriculum to be educational and useful. The curriculum and skills acquired were further translated into practice, as noted by an increase in PSE reports (186%: interns, 384%: PGY 2 and PGY 3 residents, and 613%: fellows) and positive improvements in processes of patient care, as suggested by fellows' QI projects.

Authors conclusion

A centralized, vertically integrated, competency-based curriculum is a feasible and effective way of organizing and delivering QI/PS education.

Reviewer's comment

Unlike prior literature which was limited to an individual specialty or level of training, this study details an innovative approach to teach QI/PS across a continuum of trainees, thereby eliminating heterogeneity in educational content and teaching practices within the same institution. By training core faculty members, it further describes how the deficit of skilled faculty can be diminished; thereby creating a highly efficacious QI/PS curriculum that can be replicated in various other academic institutions.

Take home pearl

Leveraging the expertise of faculty well versed in QI/PS to train other faculty members for implementation of a competency-based QI/PS curriculum across different levels of trainees, appears to be an innovative and efficacious approach to meeting curricular requirements in QI/PS that is very likely adaptable to different learning institutions and setups.


Humna Abid Memon

Educator

Humna Abid Memon, MD

About the educator

Humna Abid Memon is currently a first-year Pulmonary & Critical Care Medicine Fellow at University of Cincinnati. Her research interests include graduate medical education. Her clinical interests lie in critical care and pulmonary hypertension.